Comparison of clinical efficacy of retroperitoneal laparoscopic ureterolithotomy, ureteroscopy or microchannel percutaneous nephrolithotomy in the treatment of impacted upper ureteral calculi

Abstract

Objective To evaluate the effect of retroperitoneal laparoscopic ureterolithotomy(RLUL), ureteroscopy(URS), microchannel percutaneous nephrolithotomy(mPCNL)in the treatment of impacted upper ureteral calculi. Methods Clinical data of 105 cases with impacted upper ureteral calculi were retrospectively analyzed.The average residence time of stone in the same position was 8.6(2- 49) months and the average stone surface area were 171(71- 361)mm2 in 41 cases received RLUL treatment. The average residence time of stone in the same position was 9.5(2- 47) months and the average stone surface area were 159(71- 342)mm2 in 29 cases received URS treatment.The average residence time of stone in the same position was 8.9(2- 51) months and the average stone surface area were 165(71- 353)mm2 in 35 cases received mPCNL treatment. Results In the RLUL group,surgery was successful in all patients and the stone- free rate was 100%; In the URS group, the surgery success rate was 93.1% and the stone- free rate 1 month later was 92.6%;In the m PCNL group,the surgery success rate was 97.1% and the stone- free rate 1 month later was 97.0%. The operation time in the URS group(mean 65 min,ranged 45- 95 min) was longer than that in the RLUL(mean 46 min, ranged 25- 70 min) and m PCNL(mean 51 min, ranged 39- 80 min)groups(P 0.05). The surgery success rate, stone- free rate and the serious complications of the three groups had no significant differences(P> 0.05). Conclusion The operation time of URSis shorter, but postoperative recovery is faster than that of RLUL and mPCNL groups. Although the incidence of serious complications has no statistically significant differences among the three treatments, but URS and mPCNL surgery have the potential risk of serious complications. RLUL does not increase the difficulty of operation, has less serious complications, and is a remedy for failure in URS and mPCNL operation. Key words: Ureteral calculi; Laparoscopy; Ureteroscopy; Percutaneous nephrolithotomy